Death is a poor answer to the challenges of disability
Sir: Johann Hari's article promoting death as a solution to the challenges of severe disability (9 March) displays breathtaking arrogance and lack of understanding.
He pronounces that baby MB is "in ceaseless agony" while simultaneously noting that the baby is almost completely paralysed and unable to communicate whether or not he is in pain. The doctors who want to withdraw his ventilator admit that they do not know whether or not he is suffering, though his parents are sure that he is not.
Mr Hari approvingly quotes "the great ethicist and philosopher" Peter Singer. It should be noted that Mr Singer believes babies with any severe disability ought to be aborted or, failing that, killed as early as possible after birth. He is particularly keen on doing this for babies with spina bifida.
I am severely disabled by spina bifida, hydrocephalus, emphysema and osteoporosis. I use a wheelchair full time, and need morphine on a daily basis for severe spinal pain. Even that doesn't always work, and when the pain is bad I cannot move, speak or think. What does Mr Hari think of my "quality of life"? Should I be subjected to the lethal injection he sees as the solution to suffering?
He may respond that as I want to live, I should be allowed to do so. The problem is that I didn't always want to live. Twenty years ago, when doctors wrongly thought I was terminally ill, I wanted to die, a settled wish that lasted about ten years. Had lethal injection been an option then I would have requested it. And if I had died then I would have missed the best years of my life. I really was "screaming in agony" then and often I still am. I can only hope that when I am in great pain, Mr Hari is not around waiting in the wings to "put me out of my misery".
MILBORNE ST ANDREW, DORSET
Doctors must count costs of health care
Sir: Well said, Jeremy Laurance ("Why rationing looms for the NHS", 2 March), and curiously coincidental that Sir Nigel Crisp should now announce his retirement, accepting responsibility for the financial problems of the NHS.
One of the fundamental problems of our health service is the continuing failure of a number of my medical colleagues to engage in any form of health economic thinking. GPs will often say that they became doctors to practise medicine, and not to get involved in prioritising medical care; hospital consultants will wish to provide the best possible treatment for their patients, often without thought for the wider cost implications. Both are laudable aims, which have led to the high standard of care we enjoy today.
However, I believe that these are not sustainable views in the new world order, and that if we wish to preserve an effective health service, there must be greater acceptance at all levels of limitation of healthcare provision.
National government should take responsibility for some aspects of central prioritisation within its agreed health budget (for example, a national policy on the appropriate use of Herceptin in breast cancer). Hospital trusts need to work more closely with primary care to ensure secondary care provision is appropriate and affordable. Primary care practitioners need to be aware of the bigger picture, and not simply act as patient advocates in the absolute sense, but rather as advocates with a view to the wider health needs of society. And the public, as ultimate owner of the NHS, must take a more responsible role in determining the shape of the service, and accept its limitations.
We have achieved a health service to be proud of, but we now all need to "do our bit" to ensure its continuing viability.
DR ADRIAN CANALE-PAROLA
CHAIR, RUGBY PCT PROFESSIONAL EXECUTIVE COMMITTEE RUGBY, WARWICKSHIRE
Sir: I disagree with your article "NHS chief executive quits over cash crisis" (8 March). The current financial deficit in a minority of trusts is not a crisis, but a symptom of the NHS's recent success. It is clear that recent reforms are beginning to work and trusts have become more productive. The Government has clearly demonstrated this fact through falling waiting lists, dramatically reduced waiting times, improved facilities, more doctors and nurses and fewer winter bed crises.
The pace of reform is the real issue that you should be raising. The Government set ambitious targets, yet some trusts are working at levels beyond those targets. Before 1997, the idea of a highly productive, efficient NHS with increasing capacity seemed a pipedream. It is now a reality. If we have to apply the brakes for a short period in order to restore financial discipline, as a clinician I am happy to do so providing waiting times continue to fall for my patients.
SURESH PUSHPANANTHAN MRCS
Sir: Steve Richards describes the Liberal Democrats' call for greater localism in the NHS as "iniquitous" (9 March). Yet surely one of the besetting problems of the NHS is excessive centralisation. It is not possible for Whitehall or Westminster to provide effective control or oversight of an organisation that employs more than a million people to serve more than 40 million.
It certainly does not provide for meaningful accountability when local NHS decisions are made by people who were not elected and cannot be removed. Most of Europe woke up to the fact long ago that direct local accountability drives up standards and efficiency. Changing those at the top is not the solution; it is time that the Government gave up its control-freak tendency and made way for real local control of public services.
STEVE WEBB MP
LIBERAL DEMOCRAT SHADOW HEALTH SECRETARY HOUSE OF COMMONS
Why women are unhappy at work
Sir: Your front page on the continuing travails of women around the world ( 8 March) raises awareness of the persistent gender equality imbalance. But in its necessarily broad, global scope it was always in danger of failing to deliver focused insight on any one specific aspect of the problem.
Four of the major statistics quoted related directly to the inequality to be found in the UK employment market. Yet the true extent of the problem was left unexplored.
That women in Britain earn an average of 17 per cent less than men, and that men in Britain's finance sector can expect to earn almost one million pounds more over their lifetime than their female colleagues is damning enough. But our research has shown that female disillusionment goes deeper than pay. Almost three quarters of female professionals are disappointed with their career progress to date, and almost half do not expect to be working full time in 2010 - statistics that must be hugely worrying to UK businesses.
The common notion that it is the demands of family life that cause women to reject working conventions in favour of their own methods no longer holds true. Women today are saying they are dissatisfied with their career prospects, with their level of responsibility and autonomy, as well as with the persistent pay gap.
Employers who don't take notice will be the losers. Organisations need the skills and experience women offer and a balanced workplace benefits all employees. Employers need to ensure they increase clarity around roles and delivery expectations and recruit women at senior levels within the organisation to ensure they are in touch with their needs. This is a problem that we must prove we can tackle on the home front before we can seriously adopt an international focus.
CHIEF OPERATING OFFICER HUDSON UK LONDON WC2
Sir: Thank you for using your front page (8 March) to draw our attention in such a vivid way to the inequalities women are subject to across the world. I was prompted to count the number of men and women with by-lines in your paper up to Life and Culture and found 23 out of 34 were men. On your letters page, 12 out of 14 were sent by men. You could make a start at redressing the balance by not publishing this male-written letter!
MYTHOLMROYD, WEST YORKSHIRE
Human economy overloads the planet
Sir: I have to inform Professor Richard Bowden (letter, 3 March) that desalination plants are springing up all over the Middle East, and that British industry has, by and large, missed the boat. However, this technology, though much improved, does use a lot of energy, as does transporting water to the consumer, and the plants are mainly built to satisfy increases in population and increases in economic activity, of which Dubai is perhaps the most spectacular example. The result is yet more pressure on the finite resource called the earth.
The existing level of human activity creates environmental loads already well above that which the earth can sustain and is impoverishing the earth as a habitat suitable for humans at an ever-increasing rate. Technology-based solutions will only work if they are used to reduce environmental pressures instead of as opportunities to increase the world's GDP even faster.
James Lovelock apparently suggests that in the UK, merely to survive, we have to face going back to a GDP per head of 60-plus years ago (or face something far worse). Even though applying the technologies we already have make that and a good life a realistic target, what politician anywhere in the world will go to the electorate with that agenda?
Sir: In your report on budget airlines (2 March) you have the bald statement "The Government wants to double air passenger numbers by 2030". If this is really the case, then anything the Government says about reducing carbon dioxide emissions, or tackling climate change, can be taken to be complete baloney.
Case for badger cull far from proven
Sir: I write as a past principal of a mixed veterinary practice in Devon, to add to the badger-cull debate. Experience has made me only too aware of the distress resulting from the detection of positive reactors to Bovine TB (bTB) in a herd. Badgers play a part in the recent increase of bTB, but they are only one factor in a highly complex issue.
I carried out numerous post-mortem examinations on badgers killed in road accidents: I only found "open" TB in one old badger. Research shows 10 per cent to be positive.
My profession virtually eliminated bTB from the national herd after the Second World War. Since then stocking densities have increased greatly: grazing of badger latrine areas occurs as an inevitable response to pressure on available fodder. The yarding of cattle and use of circular feeders results in close proximity of animals; ideal conditions for respiratory viral diseases and bTB to spread.
Cattle movements have increased enormously to 14 million annually; cattle harbouring bTB are ideal vectors. Rigorous testing of all cattle would reduce this risk.
Has sufficient thought been given to other wild species as vectors of bTB? Deer are commonly infected and TB has become a major problem in farmed deer in the UK and New Zealand. Are deer to be next on the hit list?
I am very unhappy that snaring is one of the options for badger-culling: a slow suffocation of a fine strong mammal, trapped by this inhuman method. Badgers are capable of covering very large distances, so culled setts will probably be recolonised. Does this mean that long-term animal genocide is to become the norm?
NELSON L R BOWDEN
Scientific solution to a weight problem
Sir: Guy Adams (Pandora, 9 March) asks how Geri Halliwell would know that her breasts weigh around three pounds each.
Theoretically it is not such a difficult problem to solve. Human breast tissue is mostly water and by using a suitably sized receptacle filled with water, she could lower her breast into it and measure the amount of water displaced.
As 1 litre of water weighs 1 Kg she can calculate the approximate weight of each one and convert to imperial units, where 1Kg equals 2.2lb.
No doubt there will be more than a few good Samaritans out there willing to volunteer their services to help Ms Halliwell verify the theory.
ID card danger
Sir: There are two recurring characteristics of governments who introduce surveillance legislation, such as the ID cards bill. They always maintain it will be used only to improve security and detect ill-doers. They always ultimately use it to facilitate greater control over the whole of civic society.
NEWTON FERRERS, DEVON
Sir: In considering the frozen embryo case, I'm struck that the arguments revolve around the rights of the woman and the man, but not of the unborn child. Couples may split up after conception leaving children remote from one parent or the other. However, surely it is a human right of every foetus that conception comes about through a process involving two consenting parties so that the child has at least a chance of emerging into the world supported by both a mother and a father.
Sir: At Prime Minister's Questions Tony Blair referred to the tragedy of 9/11, with more than 3,000 killed, as the greatest act of terrorism the world has seen. Some would argue that the bombing of neutral Laos and Cambodia by the US during the Vietnam war, which resulted in more than a million dead, constituted a far greater act of terrorism. When the murder of innocent people is perpetrated by the state rather than by individuals, it is no less an act of terrorism.
BURY ST EDMUNDS, SUFFOLK
Sir: Like John Willoughby (letter, 8 March), I wondered who did the washing up in a paddling pool, but I fear he must have a very small washing-up bowl. In the spirit of scientific discovery, I have found that the washing up for a family of three for a day can be done with 16 litres. Furthermore, that 16 litres cleans all the wipeable surfaces in the kitchen, waters the house plants, tops up the bird bath and, in the summer, provides at least 10 litres for the vegetable patch. And, my hands are clean at the end.
Sir: Timbers falling off the new Scottish Parliament; roof leaking in the new Welsh Assembly. Is someone trying to say something about devolution?
K C GORDON
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